Obama’s Healthcare Law Takes Full Effect This Week

Nearly four years after it was signed and after months of scrambling and uncertainty, President Obama’s landmark bid to guarantee Americans health security takes full effect Wednesday as the Affordable Care Act begins delivering healthcare coverage to millions nationwide.

Administration officials reported Sunday that about 1.1 million people had enrolled in health plans using the federal website, HealthCare.gov, the main entry point for coverage in 36 states. Nearly all the enrollments came in the last couple of weeks as the deadline approached for coverage that would take effect Jan. 1.

Several hundred thousand people have enrolled on separate sites run by 14 states and the District of Columbia, with the largest figure coming from California, where more than 400,000 have signed up.

An exact count nationwide is not yet available because not all states have tallied their figures, but the total appears to be about 2 million. That remains short of the administration’s original goal of 3 million by this point, but marks a significant recovery from the system’s disastrous debut in October.

More than 4 million additional people have been found eligible for coverage under the law’s expansion of Medicaid and the Children’s Health Insurance Program.

How the law will ultimately work and whether it can endure remain unclear, though the fact that coverage will now be real for several million people will almost certainly change the debate over Republican efforts to repeal it.

While that broader political fight plays out, doctors, hospitals and pharmacies across the country are bracing for more confusion as patients struggle to understand their new coverage.